Underlying Causes
by vanillafluffy
Summary: A person's life experience shapes who they are. For Doctor Robert Chase, the burdens of growing up in the shadow of his powerful father and caring for his self destructive mother are two of the strongest influences of making him who he is today. Season 1.
1. Chromosomes

I don't own; you don't sue.

This story is a change for me; usually I write vast blocks of dialogue, but somehow, here it's minimalist. But, as a wise man said, movies are about what people say and do, prose is about what people think and feel.

The first season episode "Cursed" made a big impression on me. I've been fond of Patrick Bauchau, who was cast as Chase's father, for a long time, and wanted to explore some of Chase's issues with Rowan. One of the things that makes Robert Chase such an intriguing character is the way we never quite get inside his head--obviously, he's thinking and feeling, but we're left to wonder what's really going on under that bland exterior.

Dedicated to my father, Haakon.

**Underlying Causes**

Doctor and nurse---it's such a cliché. And yet, Cynthia fills a tremendous void in his life. He is newly arrived in a strange country---she makes him feel welcome. She is warm and sympathetic---never laughs at his accent and always explains, with infinite patience, the jokes he doesn't fully comprehend. Rowan is more at ease with her than he is with many of his peers. Seeing her outside their normal work environment seems natural, because there's never time, at the hospital, to talk about each other.

Rowan already knows Cynthia takes her work very seriously. Sometimes too seriously---she suffers for the patients, and each one she loses is fresh grief. Remarkably, she hasn't become hardened as some nurses do. She is still gentle, still kind to the most abrasive patients. "They're afraid," she reminds him, when it costs him an effort not to snarl back at a sharp-tongued patient. She's right, of course, they're in this together, doctor, nurse and patient, all fighting the patient's disease. When he focuses on that, it's easier to maintain a genial demeanor.

There's talk around the hospital---there's always talk around a hospital---and when his superiors ask him about it, Rowan quietly informs them that he's going to marry Cynthia---that he hasn't yet asked her is none of their business. She accepts his proposal, and they wed on a lovely September day. He doesn't care about all the formalities: she's his, that's all he's ever wanted. Doctor and Mrs. Chase toast each other with champagne and get a little tight, but by the end of the festivities they're both in a very good mood and more than ready for the wedding night.

The wedding photographer snaps what seems like hundreds of shots because her family is paying for everything and they want pictures. Studying them later, Rowan is surprised. He's never given much thought about how they appear as a couple, but he has to admit, they look good together. He's a lumbering bear of a man. Cynthia doesn't quite come up to his shoulder and she's a hummingbird of controlled energy and grace. The contrast is striking.

At the wedding, Cynthia wears her light red-gold hair styled like Princess Diana, and her wide blue eyes meet the camera over a delighted smile. In one picture, they're standing face-to-face, and he has his arms around her, glaring at the photographer and holding his bride protectively. The flash has captured the belligerent expression on his face as surely as it did his dark auburn hair and his green eyes.

"That's a nice one, I must say!" Cynthia chuckles as they thumb through the proofs. It was a lot of silly fussing, and he tells her so.

"When we're showing these pictures to our grandchildren, you'll think otherwise," is her sage reply. Doctor Rowan Chase smiles and agrees.


	2. Gestation

Cynthia experiences gestational diabetes during her pregnancy, and he orders bed-rest. Rowan worries about her for months on end, but Cynthia is serene from first to last. She spends a lot of time fingering her rosary, blue eyes fixed on a realm he can't see. Since it keeps her calm, Rowan doesn't comment on it. He's been a doctor long enough to accept that he doesn't know everything; the role of mind over matter can't be discounted completely.

Their son Robert is born two weeks early after a hard labor, but he's in good condition. The relief that Rowan feels overwhelms him. Although it isn't his specialty, he's delivered babies before, but none of them has ever been so precious, so miraculous. Holding his son in the delivery room, rocking the squalling infant, the salt of his joyful tears flows to mingle with the birth fluids still wet on the tiny body. There is evidence of ginger-colored fuzz on his delicate head. He's as fair as his mother, and so compact that Rowan thinks Robert will be slightly-built as well.

Cynthia needs emergency surgery and Rowan is torn between rejoicing for his son and concern for his wife. He relaxes when the hysterectomy is trouble-free. Robert will be their only child, and his mother is upset. They were going to have three children, it's not fair! she laments. Rowan shrugs. There's nothing he can do about it, is there? It's pointless to complain. They have a son; he's healthy and vigorous. Cynthia recovers her strength, but her disposition has changed.

When they bring Robert home, trouble begins. Cynthia has worked neonatal---she knows how to care for an infant. Here, it's just her and Robert, and Rowan is impatient when she calls him in a panic over every minor event. How difficult can it be, to look after one beautiful little child? Fathers are supposed to be proud of their children, but until now, he hasn't had a clue what that meant. Rowan was the youngest of six, and his father rarely had time for any of them.

The first thing he does when he returns home every night is to examine his son. Rowan makes time consistently, and so he notices, as Robbie approaches ten months of age, that he seems to be more quiet than usual in recent evenings. Lethargic, even. Rowan says nothing to Cynthia, not wanting to worry her, but draws a small vial of blood from his son to test for things no father wants to find.

First he's stunned, then he's furious. He's seldom raised his voice to Cynthia, much less his hand, but when he returns home, Rowan seizes her by the shoulders and shakes her. What has she been doing, putting alcohol in their son's bottles? What was she thinking? Cynthia weeps. Her hair, longer now, veils her face. "He cries all the time! Sometimes he screams for no reason, just screams and screams! I thought I'd go mad! I needed something for my nerves."

The mystery is solved. The alcohol was passed along to the infant through breast-feeding.

Rowan is exasperated. A nurse ought to know better.


	3. Exploratory

Robbie is four when his mother takes him to the beach for the day. His father has to work, but they'll have fun, just the two of them, she promises. There's a cooler with a picnic lunch, a thermos of lemonade for Robbie and a thermos of lemonade for Mum so they don't get each other's germs. Mum rubs sunscreen on him and tells him not to go past the rocks on that side or the life-guard stand on the other side. And don't go into the water without her! She's tired from the drive to the beach and needs to close her eyes for a while.

While Mum takes a nap, Robbie makes a new friend, and they build a sand-castle together until the other boy's mum calls him for lunch. He's hungry too, but Mum is still sleeping and he knows she doesn't like it when he wakes her. If it's time for that other boy's lunch, it must be time for his lunch, he decides with his rumbling tummy to back him up. He eats one of the sandwiches with a big pickle and a frosted cupcake, and drinks the rest of his lemonade.

He rejoins the other boy at their sand-castle, and they play invasion of the killer shark monsters until the other mum calls his friend to go home. Robbie's mum is still stretched out on the beach blanket, and Robbie sighs. He's thirsty. His lemonade is gone, but there's still some left in Mum's thermos. He thinks very hard about germs, and arrives at the conclusion that if he uses the cup from his thermos, it should be okay. And if he does get any germs, Daddy is a doctor and he can fix it anyway, and besides, Robbie's really thirsty. And hungry. He takes another sandwich from the cooler.

Can lemonade go bad, or did she use too many lemons? It's bitter, kind of, and burns when he swallows it. Robbie eats the sandwich and haltingly drinks the sour lemonade. Except for building the sand-castle, he hasn't had very much fun today. He's so hot...his skin is bright pink, how silly that looks. He wonders if the pink will wash off. It would be awful for it to stay that way---pink is for girls. Maybe it would be okay to go into the water just a little bit to rinse off the pink? Its sunlit ripples glitter like ice cubes in a cool glass of water.

The waves beckon him, and with one last glance at Mum, Robbie heads toward the bright blue ocean.


	4. Deficit

The hospital switchboard pages Doctor Rowan Chase in the middle of an important departmental meeting; he's angrier still when he learns that he'll have to drive thirty clicks during rush hour traffic to fetch his child while the local constabulary holds his wife in custody. At his entrance, the little boy jumps up from a chair in the corner of the police station and runs to throw his arms around his father. His little voice is shrill as he begs Rowan to make the policemen let Mum go.

Robbie's fair skin is going to blister, is Rowan's first thought. He's aghast at the angry puce that covers most of his son's slight form. The boy is dehydrated as well, and his father detects an odor of vomit.

The constable verifies that Robbie sicked up on the lifeguard who'd noticed the boy heading directly for the water without supervision. Robbie yelled and fussed when stopped, just as he was taught to do when approached by a stranger, but Cynthia didn't respond. The lifeguard had noticed him going back and forth to the blanket during the day, and when he dragged Robbie over there, discovered the boy's mother was...under the weather.

Reassuring the little boy, Rowan arranges to have Cynthia's car towed home. Emotions are a tangled knot in Rowan's chest. Foremost is horror that he might have lost his son, followed closely by his shame at Cynthia's condition and rage that she allowed this to happen. His wife is escorted to the waiting room, and her husband gives her one severe look before talking Robbie by the hand and guiding him out to the car, Cynthia stumbling in their wake. It's a long drive back to their home, Robbie whimpering from the pain of his sunburn. His wife vomits in the back seat, making the atmosphere in the car doubly unpleasant.

One of the useful things about being a rising doctor on the staff of a good hospital: doctors protect their own, and when he checks his wife in for detox, she's well cared for. The tox screen comes back as borderline alcohol poisoning, and he shudders at how the day's outing has nearly cost him his family.

It's more than a little ironic that he ends up hiring a newly-retired nurse of his acquaintance to mind Robbie while his mother is in rehab. Cynthia, when she's sober enough to realize what happened to them, is mortified. Her contrition is wholly sincere, and Rowan hopes she'll stay cleaned up.

Just in case, he signs Robbie up for swimming lessons as soon as his sunburn has healed.


	5. Trauma

Their new house has a pool, and it's much closer to the all-boys Catholic school that eight-year old Robert Chase goes to, but he never invites his friends home when classes let out. Partly it's because he's already been double-promoted, and the older boys who are in the same classes he's in aren't interested in hanging out with him. He's into football as well, but even though those fellows are his age, he doesn't want to get too matey with them.

They might disturb Mum, and Robert knows he can't let that happen. She's unwell a lot, and they wouldn't understand. Dad says he's done everything he can for her, she's the only one who can make herself better, but sometimes he daydreams that one evening his father brings home a cure. And his mother drinks it down---she makes a face at the taste, everyone knows the worse medicine tastes, the better it is for you---and it's like she wakes up then, and kisses his father and hugs him and after that, there aren't any more bad times. When he finally brings his friends round, they're all envious because his mum is so great.

Robert's grades have to be the best in his class, because that earns him a rare "Well done" from his hard-working dad. By the time he's ten, his instructors and the school administrators are saying he can begin at high school next year, as long as he keeps on as he has been. So he gives up football---he can't afford the time---and comes home and studies. Once in a while, when he's restless and has trouble focusing, he'll allow himself a quick swim. In all the time they've lived in that house, he's the only one who's ever swum in the pool.

It's a good thing he had those lessons, too, because one of the first things he was taught was how to do CPR. Robert comes home one day when he's thirteen, and at first his mum seems, well, a bit groggy, but then she goes silent and he realizes, with a rush of cold terror that she's not breathing. He pulls her off the couch and lays her out on the hardwood floor. She's staring at nothing and still, so very still. And he goes at CPR the way they showed him, frightened, wondering if he should run and call treble zero or if he should keep trying. Tears sting his green eyes and what's he going to do if she's dead? How can he ever explain such a colossal failure to his father?

Mum coughs, and Robert prays, "Please, God, You can do this. Please let her live. I'll do anything You want, I'll be a monk and live in the desert if that's what it takes, please, God---!" Then she's barfing, hurling so hard that for a few minutes, he's afraid she's going to hurt herself, but she's breathing---not well, but breathing.

He knows enough to lay her on her side so she doesn't choke and then he calls the rescue squad. When they've taken her off to Dad's hospital, he gets the shakes. Thinking about what his dad is going to say makes him sick to his stomach, but he makes it to the lav, bringing up his lunch and curling up in a ball on the floor, shivering. How does his dad handle all this life and death stuff every day?

After a while, he feels a bit less wobbly, so he gets out the wet-dry vacuum and cleans up his mum's mess. It isn't the first time he's had to do that.


	6. Triage

Enough is enough. Rowan Chase is tired of constant drama with Cynthia. He wants a calm, orderly home life---no more drunken outbursts for them to endure, no more distractions for Robert, who has, despite his mother's continual crises, made it through his first year of college---at fifteen! He couldn't possibly be more proud of his son. He isn't pleased that the boy has insisted on attending a seminary---he has some cockamamie idea of doing missionary work---but he's young. There's still time for him to change his mind about this ascetic nonsense.

Cynthia is sullen and bitter as he packs, and there is one last volley of mutual accusation. He finally throws his last suitcase into the back of his car and goes to see how Robert is coming with his belongings. There's no sign he's even begun to gather his things. Robert sits at his desk, tapping his pen against his teeth and from time to time making careful notes from the book in front of him. He looks up at Rowan thoughtfully. "Go?" he repeats. "I can't go anywhere tonight, Dad. I have a paper due tomorrow."

After the paper is turned in, his excuse is mid-terms. Then a group project, finals, summer school---Rowan realizes that Robert has no intention of leaving Cynthia alone. He's noncommittal every time his father calls, but Rowan can hear it, the surly undertone that says, "If you won't take care of her, I will." It breaks a father's heart to know his child is on the wrong path. Obviously, the boy is brilliant--he's so far ahead of his age-mates it's laughable, and he's managed it with the handicap of looking after an alcoholic mother who by rights ought to be looking after him. Rowan shakes his head, wondering where it all went wrong.

Standing beside his ex-wife's grave a couple of years later, Rowan looks at his son and realizes how much more Robert resembles Cynthia than he does his father. He has the same fair skin and straight red-gold hair. He'll never have Rowan's height, although he's taller than his mother was. He's slim and athletic and possesses the same vibrant energy his mother had, back when she was the pretty young nurse who cared too much.

Their cleaner came in to work four days ago and found Cynthia dead on the kitchen floor in a puddle of gin and ice-melt, a broken glass nearby. Alcohol poisoning--not surprising, really, in light of her history. Robert returned home a scant hour later from a three-day retreat to the commotion of police and the coroner. He's taken charge, handled all the funeral arrangements with stoic resolve, and Rowan marvels at how mature he is at barely eighteen.

After the service, they converse briefly in the parking lot. Rowan reassures his son that it isn't his fault, that there was nothing he could do. His son nods, coppery strands fluttering back from his face. At the last minute, after Rowan's gotten into his car, Robert mentions---as if it's inconsequential---that he's left the seminary. He's changing his major to pre-med. Before his surprised father can say anything, Robert turns on his heel and walks away.

It's a tragic victory, thinks Rowan, but his son is going to be a damned fine doctor some day.


	7. Heroic Measures

Residency, where Doctor Robert Chase actually has to put what he's learned from books into practice, is full of surprises. Patients generally have no idea who his father is. They're grateful to _him_, and that's a first. His confidence grows; he really _can _help people, his efforts aren't in vain. He goes from one floor to another, plenty of good will in his wake, because he's conscientious and polite. He speaks up if it's important, but mostly he's quiet and listens, because the senior doctors have the experience he still needs and there are things you can't learn from books.

Clinic duty is his first assignment. It isn't horrible, but it's not what he wants to do for the next thirty or forty years. Surgery is interesting, but not to practice on a daily basis. Likewise, internal medicine is a bit of a grind. Obstetrics and gynecology are educational for a guy who hasn't had time for ladies, but it's impossible for him to maintain the necessary clinical attitude about the fairer sex. The only rotation he has real trouble with is Psych. He feels sympathy for the patients, some of whom are nice enough people, but he keeps having massive nightmares about being over-medicated and drooling, strapped down and given ECT, being locked away in darkness forever. This is definitely not the career for him; although he gives it a fair go, he's relieved beyond words when he's transfered out.

When he and Skinner get paired up for ICU rotation, that's when things get interesting. Skinner has already settled on dermatology for advanced training (Robert snickers at the irony), and is waiting for an opening in that department. Their first day, they've been on the ward for less than an hour, when a post-op patient starts vomiting. As they bolt into the patient's room, Skinner freezes. Robert feels the tingle of adrenalin in his veins and a sense that time has slowed down. He grabs the suction device and aspirates the airway and it's easy, really. Christ, he's done this for Mum more than once with just a hand vac, it's nothing to go to pieces over. What the hell is Skinner's problem?

By the time the attending doctor has arrived in response to Skinner's frantic page, the patient's vital signs have stabilized. Fortunately, the surgical incision hasn't been compromised. Robert gives a crisp outline of what he's done for the woman as the attending nods. Afterward, he doesn't feel gratified, or elated, just...centered. That's only the first crisis of what proves to be a very busy shift, and with each successive incident the sense of focus sharpens. Even though one of their patients doesn't make it, he accepts that---he already knows you can't save them all---and goes on to another bedside, another moment of clear intensity.

This is it. _This_ is what he wants to do. It calls on all his brains and training and reflexes and it gives him such a buzz and yet it's curiously peaceful, like those long ago moments of transcendent prayer when he felt a connection to something greater than himself.

Skinner struggles for four days, and then flees into the safe, dull haven of dermatology. Doctor Robert Chase is too busy to say good-bye.


	8. Oblique

Rowan has lunch with Tomas Bourges, who used to be on staff with him at Harrison Memorial. After the usual discussion of who's been doing what and the latest news of their mutual friends, Tomas has a lot to say about Robert. According to Rivera, who's in Bourges' golf foursome, his son is thinking of applying for a fellowship in the States.

His son is making quite a name for himself. He hears respect in Tomas's tone. More than one of his longtime colleagues has worked with Robert, and the word that's gotten back to his father is all good. 'Driven' and 'dedicated' are words he hears a lot. Rowan wonders, as he toys with his shrimp, how much of that dedication comes from him, and how much of it is the ghost of Cynthia haunting their son. Or...perhaps he's trying to outrun his father's shadow, to make his own professional reputation.

The devil of it is, he'll probably never know what drives his son. He and Robert don't see each other often. They don't work in the same hospitals, and Rowan suspects that's deliberate. He hardly knows the boy anymore. His son has kept his distance for a long time. Even before Rowan's separation from Cynthia, there were too many years when they saw each other only for Sunday dinner or briefly in passing as one of them was coming or going. He was always busy with work, Robert was always studying. When he thinks about it, he doesn't really know who Robert is.

He asks Tomas a few casual questions, and when he gets back to his office, does some quick research on Princeton-Plainsboro Teaching Hospital. The results are impressive: it's one of the best facilities of its kind in the world, cutting edge, with names on staff that he recognizes from his journals. Stahl, the head of orthopedics, is sometimes referred to as the Michelangelo of reconstructive surgery. Fitchner has pioneered new transplant techniques and has been mentioned as a possible Nobel laureate. House, whose fellowship Robert is applying for, is reknowned as a brilliant diagnostician. Every single department at PPTH seems to have a star, major or minor. This is what Robert wants: to learn from the best. Rowan feels a sense of pride that his son has such high standards.

With the feeling that there's finally something he can do for his son, Rowan Chase makes a phone call.


	9. Consultation

Things are different in America. He's surrounded by people speaking his native tongue with a peculiar accent---and they all think he's the one who's talking funny. The climate isn't what he's used to, either, but one truth is universal: the patients still hemorrhage, code and die the same as Down Under.

Here, _he's _Dr. Chase---he's used to being addressed by his surname from his school years, but it's no longer followed by 'Oh-you're-_Rowan's_-son-aren't-you?'---and once he realizes that, proving himself becomes much easier. Tucker, another of House's fellows, says their mentor is a bastard, but Tucker---who's eight years older than he is---is a load of figjam. He's been coasting on modest brains and charm, and House doesn't give a rat's ass about charm. Tucker and DiBiase whinge about House's abrasive manner, but Chase has no problem with it. Whatever else you may think of the senior doctor, he's dead honest, and to Chase's way of thinking, that's a good thing. He may insult and criticize and badger them all, but you always know what's on his mind. He's not going to keep things inside, and then one day surprise you with a curt, "Enough is enough. Get packed."

When DiBiase quits and House brings in an immunologist named Cameron, Chase gets to her before Tucker can clue her in on her new boss. "He's a tough bastard, but you'll learn a lot. He'll try to make you doubt yourself. As long as you know what you're talking about, you'll be okay. Don't try to bluff him. It won't work. Don't get in his face, but don't back down. You've got the right stuff, or he wouldn't have hired you."

When he's the senior fellow, it's him and Cameron and a guy named Foreman---a neurologist, good guy, good doctor---although Foreman pushes back when House gets in his face. Sometimes that annoys the hell out of Chase. He learned long ago that being low-key and smart gets better results than being confrontational, but House screws with all of them equally. He picks on Cameron because she's pretty and tender-hearted, Foreman because he's black and used to be a delinquent, and himself for being Aussie and, according to his boss, a suck-up. House is entitled to his opinion, so Chase shrugs off the implied slur.

His private life isn't much better than it was when he was in school; he hasn't found anyone to be with on a long-term basis. He's has a couple brief affairs, but in the long run, it's easier to just do his job and go home and not get into relationships that are sure to end messily. Being a workaholic isn't hard when you love your job, and Chase does. Medicine has taken the place of God in his life. He's dedicated himself to it; sometimes this vocation also leaves him bitterly disappointed, but he still needs it, needs its mysteries to ponder and its continual testing of who he is.

His dad comes over for a conference, and House gets him to consult on their current case, a young boy whose symptoms are baffling. Being "Rowan Chase's son" again stirs up a lot of old trash, but in the end, it dawns on him: this is his dad, reaching out to him for a change. They've been debating diagnoses for days, but his dad hasn't stepped over the line between their personal business and their mutual profession. And now that he's where he is in his own life, Robert Chase can admit that it would be easy to neglect a family in pursuit of his calling. He can't blame his dad for that any more.

He catches Rowan on his way to the airport, and although they don't have much time, the ice between them is finally broken. The next time he visits, Doctor Robert Chase promises himself, they'll melt the rest of it.


	10. Closure

There's a whole continent to cross, as well as a vast ocean, and Rowan Chase has many hours in which to think. He knows with inevitable certainty that he'll never see his son again. As painful as that realization is, he can console himself with the thought that he's finally had the opportunity to witness for himself the outcome of that long ago miracle birth, the beautiful child who is now a clever, capable man.

Why let reconciliation go just because he's dying? He'll leave a letter for Robert with his solicitor, to ease him through the shock.

Pulling a tablet out of his briefcase, he scrawls the date at the top, and begins to write: _From one Doctor Chase to another--- _

I hope you won't be too angry with me when you read this. I came to the States to talk with you and to consult with Dr. Wilson on my own case. By now, you will understand what I mean. _When I came, it was with the intention of being honest with you about my condition, but in the end, I couldn't do it._

Rowan pauses, looking at the written words. Soon, the balance is going to change forever: he will be the patient, the one helpless before the onslaught of his lifelong enemy. But it's been a good life, nonetheless, and his son gives him hope for the future. Rowan won't live to see grandchildren, that's a foregone conclusion---but over the years, he's encountered some of his former patients with their children and grandchildren, and in a sense, they're his, too...

Observing Robert with the young patient they treated, Rowan noted the same compassion that made his mother such a good nurse...but also a courage Cynthia never possessed. _Driven_, Rowan remembers Tomas telling him. Now that he's seen his son in action, Rowan agrees. The stubborn persistance that once made Robert an exemplary student is saving lives. If the younger man has doubts about himself, he doesn't show them.

I have watched you work, and I admired your competence and grace under pressure. You've always been remarkably self-reliant, but knowing that others can rely on you with their lives made me proud. And yet, the more I watched, the more I became aware that I shouldn't take credit for any of it.

I may have enabled your education, but what you have made of your life owes nothing to me and _everything to your own keen mind and strong heart. Realizing this, I chose, perhaps selfishly, to try to gain your respect rather than your pity. I hope you can forgive me for that. _

Good-bye, Robbie. I wish you could know how much I have always loved you.

Your father,  
Rowan

**The End.**

* * *

Once of the reasons I relate to Chase is because I also lost my father to lung cancer. I still miss him. Happy Father's Day, Daddy. 

A big thanks to all my lovely readers, and an even bigger thanks to my reviewers. I appreciate everyone's enthusiasm and support very much!


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